From the Guidelines
Contracture treatment should involve a combination of physical therapy, stretching exercises, splinting, and in some cases, medication or surgery, with the goal of preventing disabling complications and improving mobility and quality of life. The treatment approach should be individualized, taking into account the severity and location of the contracture, as well as the patient's overall health and functional status.
Key Components of Contracture Treatment
- Regular stretching exercises performed several times daily to gradually lengthen the contracted tissues
- Physical therapy, including passive and active range-of-motion exercises, massage, and ultrasound therapy
- Splinting or casting to provide prolonged stretching, typically worn for several hours daily or overnight
- Medications such as oral baclofen, tizanidine, or dantrolene to manage spasticity and pain
- Botulinum toxin injections to relax muscles and reduce spasticity
- Surgical interventions, such as tendon releases, capsulotomies, or skin grafting, for established contractures that are resistant to conservative treatment.
Prevention and Early Intervention
Prevention of contractures is crucial, and early intervention is key to preventing disabling complications. Patients with paretic limbs and muscle spasticity are at high risk of developing contractures, and regular movement and proper positioning are essential for at-risk individuals 1.
Treatment Considerations
The treatment approach should be tailored to the individual patient's needs, and a multidisciplinary team approach, including physical therapists, occupational therapists, and physicians, is often necessary to achieve optimal outcomes.
Evidence-Based Recommendations
The most recent and highest quality study recommends a stepwise approach to treating spasticity and contractures, starting with noninvasive modalities such as positioning, passive stretching, and range-of-motion exercises, and progressing to more invasive modalities such as oral medications, botulinum toxin injections, and surgical interventions as needed 1.
From the Research
Contracture Treatment Options
- Physical therapy and splinting are initial management options for contractures, as seen in patients with spastic upper extremity 2
- Botulinum toxin can be used as a therapeutic treatment to relieve spasticity and as a diagnostic tool to determine the underlying cause of the contracture 2, 3
- Surgical management options, such as release or lengthening of the causative muscle/tendon unit and joint capsular release, may be necessary for contractures resistant to conservative treatment 2, 4
Conservative Treatment Approaches
- Physical therapy, including passive and active kinesitherapy, can help reduce postoperative swelling and improve range of motion 4
- Intensive postoperative physiotherapy is important to maintain improved range of motion and protect any associated tendon lengthening or transfer 2, 4
- Splinting and bracing can help minimize the impact or disability from contractures 5
Surgical Interventions
- Arthroscopic synovectomy can be an effective treatment option for contractures in patients with chronic juvenile arthritis 4
- Surgical tenotomies, such as release or lengthening of the causative muscle/tendon unit, can help correct deformities and improve range of motion 2, 6
Multidisciplinary Approach
- A combined interdisciplinary rehabilitation approach, including pre- and post-operative physiotherapy and kinesitherapy, is important for effective management of contractures 4
- Long-term management programs are necessary to prevent recurrence of contractures, as predisposing factors can persist after treatment 6